67:16:35:03.  Claims limited to items and services covered under article. A provider may submit claims only for those supplies and services that the provider knows, or should have known, are covered under this article. A provider, other than a school district, may not submit claims for services to children under the age of 21, if the provider knows or should have known that the services are listed in the child's individual education plan.

    The submission of a claim containing miscoding that may result in inflated reimbursement or in reimbursement for noncovered services under this article is considered abuse of the program and possible fraud and may be cause for terminating the provider agreement.

    Source: 15 SDR 2, effective July 17, 1988, transferred from § 67:16:01:07.02, 17 SDR 4, effective July 16, 1990; 17 SDR 184, effective June 6, 1991; 19 SDR 26, effective August 23, 1992; 19 SDR 165, effective May 3, 1993; 49 SDR 21, effective September 12, 2022.

    General Authority: SDCL 28-6-1.

    Law Implemented: SDCL 28-6-1(4)(6).

    Cross-Reference: School districts, ch 67:16:37.